When to refer

Clinicians should offer menopause advice within their clinical expertise and seek further input as appropriate.

Criteria for referral may include:

• Women who experience difficulty obtaining symptom control despite lifestyle measures and adjustments to their HRT.
• The woman has persistent adverse effects.
• Women experiencing unscheduled bleeding >4-6 months after starting HRT despite adjustments to the progestogen dose.
• Women where the diagnosis of POI is inconclusive.
• Women with complex medical backgrounds or contraindications to treatment.
• Uncertainty about the most suitable treatment option for troublesome menopausal symptoms.
• Women with genitourinary symptoms who do not obtain satisfactory symptom relief despite using vaginal treatments.
• Women who would like to discuss testosterone supplementation for symptoms of altered sexual function.
• Other related issues where specialist input may be required.